Navigating the Green Card Backlog: Challenges in Hiring International Nurses & Alternative Visa Solutions
The United States is currently grappling with significant backlogs in green card processing, particularly within employment-based categories. These delays have profound implications for both international professionals seeking permanent residency and the U.S. industries that rely on their expertise, such as the healthcare sector.
Current State of Green Card Backlogs
As of January 2025, the employment-based green card backlog encompasses over 1.2 million individuals, including principal applicants and their family members. This accumulation results from a combination of legislative caps and administrative inefficiencies. Notably, the Immigration and Nationality Act of 1965 imposes an annual limit of 140,000 employment-based green cards, with a per-country cap of 7%. These restrictions disproportionately affect applicants from countries with high demand, such as India and China, leading to wait times that can extend beyond a decade.
Administrative challenges further exacerbate these delays. For instance, the approval time for a Form I-140 (Immigrant Petition for Alien Worker) has increased from a few weeks in 2019 to approximately 6–8 months as of 2025. Such prolonged processing times contribute to uncertainty for both employers and foreign workers, impacting long-term workforce planning.
Implications for Hospitals and International Nurse Recruitment
The healthcare industry, particularly hospitals, faces significant challenges due to these backlogs. The U.S. is experiencing a nursing shortage, with projections indicating a substantial deficit by 2025. Despite the pressing need, qualified international nurses often find themselves entangled in the green card backlog, delaying their ability to commence employment. This situation hampers hospitals' efforts to maintain adequate staffing levels and meet patient care standards.
Relying solely on green card applicants for international nurse recruitment is increasingly untenable. The unpredictability and length of the green card process make it difficult for healthcare facilities to develop effective hiring strategies. Consequently, hospitals are exploring alternative visa options to expedite the onboarding of international nurses.
Alternative Visa Options: TN and H-1B Visas
Two viable alternatives to the green card route are the TN (Trade NAFTA) and H-1B visas:
TN Visa: Available to Canadian and Mexican citizens under the United States-Mexico-Canada Agreement (USMCA), the TN visa allows professionals, including registered nurses, to work in the U.S. on a temporary basis. The application process is relatively swift, often taking a few weeks, enabling hospitals to address staffing needs more promptly. However, it's important to note that the TN visa is non-immigrant and does not provide a direct pathway to permanent residency.
H-1B Visa: This visa permits U.S. employers to hire foreign workers in specialty occupations that require specialized knowledge and a bachelor's degree or higher. While registered nursing positions have not traditionally qualified for H-1B status, certain advanced practice nursing roles or positions requiring specialized skills may meet the criteria. The H-1B visa is also a non-immigrant visa but allows for dual intent, meaning holders can pursue permanent residency concurrently. The application process is more complex and subject to annual caps, which can limit availability.
Conclusion
The current green card backlogs present substantial challenges for international professionals and the U.S. industries that depend on their expertise. For hospitals striving to maintain adequate nursing staff, relying exclusively on green card applicants is increasingly impractical. Exploring alternative visa options, such as TN and H-1B visas, offers a more immediate solution to address critical staffing shortages. However, these are temporary fixes. Comprehensive immigration reform is essential to resolve the underlying issues contributing to these backlogs and to ensure that the U.S. healthcare system remains robust and responsive to the nation's needs.
